Epileptogenic potential of mefloquine chemoprophylaxis: a pathogenic hypothesis
Abstract Background Mefloquine has historically been considered safe and well-tolerated for long-term malaria chemoprophylaxis, but prescribing it requires careful attention in order to rule out contraindications to its use. Contraindications include a history of certain neurological conditions that...
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ftdoajarticles:oai:doaj.org/article:9e3c823b898d42bd8ed8a25fb191b8d9 2023-05-15T15:08:45+02:00 Epileptogenic potential of mefloquine chemoprophylaxis: a pathogenic hypothesis Nevin Remington L 2009-08-01T00:00:00Z https://doi.org/10.1186/1475-2875-8-188 https://doaj.org/article/9e3c823b898d42bd8ed8a25fb191b8d9 EN eng BMC http://www.malariajournal.com/content/8/1/188 https://doaj.org/toc/1475-2875 doi:10.1186/1475-2875-8-188 1475-2875 https://doaj.org/article/9e3c823b898d42bd8ed8a25fb191b8d9 Malaria Journal, Vol 8, Iss 1, p 188 (2009) Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 article 2009 ftdoajarticles https://doi.org/10.1186/1475-2875-8-188 2022-12-31T12:31:58Z Abstract Background Mefloquine has historically been considered safe and well-tolerated for long-term malaria chemoprophylaxis, but prescribing it requires careful attention in order to rule out contraindications to its use. Contraindications include a history of certain neurological conditions that might increase the risk of seizure and other adverse events. The precise pathophysiological mechanism by which mefloquine might predispose those with such a history to seizure remains unclear. Presentation of the hypothesis Studies have demonstrated that mefloquine at doses consistent with chemoprophylaxis accumulates at high levels in brain tissue, which results in altered neuronal calcium homeostasis, altered gap-junction functioning, and contributes to neuronal cell death. This paper reviews the scientific evidence associating mefloquine with alterations in neuronal function, and it suggests the novel hypothesis that among those with the prevalent EPM1 mutation, inherited and mefloquine-induced impairments in neuronal physiologic safeguards might increase risk of GABAergic seizure during mefloquine chemoprophylaxis. Testing and implications of the hypothesis Consistent with case reports of tonic-clonic seizures occurring during mefloquine chemoprophylaxis among those with family histories of epilepsy, it is proposed here that a new contraindication to mefloquine use be recognized for people with EPM1 mutation and for those with a personal history of myoclonus or ataxia, or a family history of degenerative neurologic disorder consistent with EPM1. Recommendations and directions for future research are presented. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Malaria Journal 8 1 |
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Directory of Open Access Journals: DOAJ Articles |
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English |
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Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
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Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 Nevin Remington L Epileptogenic potential of mefloquine chemoprophylaxis: a pathogenic hypothesis |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
description |
Abstract Background Mefloquine has historically been considered safe and well-tolerated for long-term malaria chemoprophylaxis, but prescribing it requires careful attention in order to rule out contraindications to its use. Contraindications include a history of certain neurological conditions that might increase the risk of seizure and other adverse events. The precise pathophysiological mechanism by which mefloquine might predispose those with such a history to seizure remains unclear. Presentation of the hypothesis Studies have demonstrated that mefloquine at doses consistent with chemoprophylaxis accumulates at high levels in brain tissue, which results in altered neuronal calcium homeostasis, altered gap-junction functioning, and contributes to neuronal cell death. This paper reviews the scientific evidence associating mefloquine with alterations in neuronal function, and it suggests the novel hypothesis that among those with the prevalent EPM1 mutation, inherited and mefloquine-induced impairments in neuronal physiologic safeguards might increase risk of GABAergic seizure during mefloquine chemoprophylaxis. Testing and implications of the hypothesis Consistent with case reports of tonic-clonic seizures occurring during mefloquine chemoprophylaxis among those with family histories of epilepsy, it is proposed here that a new contraindication to mefloquine use be recognized for people with EPM1 mutation and for those with a personal history of myoclonus or ataxia, or a family history of degenerative neurologic disorder consistent with EPM1. Recommendations and directions for future research are presented. |
format |
Article in Journal/Newspaper |
author |
Nevin Remington L |
author_facet |
Nevin Remington L |
author_sort |
Nevin Remington L |
title |
Epileptogenic potential of mefloquine chemoprophylaxis: a pathogenic hypothesis |
title_short |
Epileptogenic potential of mefloquine chemoprophylaxis: a pathogenic hypothesis |
title_full |
Epileptogenic potential of mefloquine chemoprophylaxis: a pathogenic hypothesis |
title_fullStr |
Epileptogenic potential of mefloquine chemoprophylaxis: a pathogenic hypothesis |
title_full_unstemmed |
Epileptogenic potential of mefloquine chemoprophylaxis: a pathogenic hypothesis |
title_sort |
epileptogenic potential of mefloquine chemoprophylaxis: a pathogenic hypothesis |
publisher |
BMC |
publishDate |
2009 |
url |
https://doi.org/10.1186/1475-2875-8-188 https://doaj.org/article/9e3c823b898d42bd8ed8a25fb191b8d9 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Malaria Journal, Vol 8, Iss 1, p 188 (2009) |
op_relation |
http://www.malariajournal.com/content/8/1/188 https://doaj.org/toc/1475-2875 doi:10.1186/1475-2875-8-188 1475-2875 https://doaj.org/article/9e3c823b898d42bd8ed8a25fb191b8d9 |
op_doi |
https://doi.org/10.1186/1475-2875-8-188 |
container_title |
Malaria Journal |
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8 |
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1 |
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1766340053777252352 |